Psychiatric coercion, beneficence, and reason-responsive agency: a mixed-methods study after suicide-attempt care in...

Coercion in psychiatric care is often presented as a conflict between autonomy and beneficence. This framing is ethically useful, but it can obscure whether coercive care treats persons in crisis as agents who remain entitled to reasons, participation, and support. This sequential explanatory mixed-methods study examined coercion after suicide-attempt care in Caldas, Colombia. Quantitative analyses used 155 matched dyads of service users and the professionals involved in their care. Measures assessed perceived coercion, professional-reported coercive practices, stigma-related attitudes, depressive symptoms, subjective well-being, and sense of community. Qualitative analysis drew on 60 in-depth interviews with service users and professionals. Service-user perceived coercion was associated with higher depressive symptoms, professional-reported coercive practices, and authoritarian professional attitudes. Regression models explained 43.6% of the variance in professional-reported coercive practices. Interviews showed that coercion was commonly described as protection, protocol, or professional duty, with limited reference to rights, supported decision-making, or less restrictive alternatives. These findings do not establish that coercion is never justified. They suggest, more narrowly, that post-suicide-attempt coercion may be ethically defective when it bypasses reason-giving, reduces agency to clinical manageability, and normalizes paternalistic routines as beneficence. A reason-responsive account of respect clarifies why reducing coercion requires not only procedural safeguards, but also practical infrastructures for supported decision-making and non-coercive crisis care.